Allergy + Immunology Flashcards
What types of medications give serum sickness?
anti-rejection meds
antitoxins
antivenoms
What medications can give serum sickness-like reactions?
penicillins
sulfonamides
cephalosporins
streptomycin
hydantoins
griseofulvin
bupropion
fluoxetine
thiouracil
infliximab/rituximab
When does serum-sickness present?
7-14 days after initial exposure (can be less if re-exposure)
What is the pathophysiology of serum sickness?
- protein exposure
- antigen excess
- antibody response - antibody-antigen complexes
- deposition of immune complexes in tissues causing local inflammation and complement activation
- increased vascular permeability, histamine release, bronchospasm
What are the symptoms of serum sickness?
fever
malaise
rash
arthralgias/arthritis
lymphadenopathy
angioedema
nephritis (hematuria, edema, oliguria)
less common:
abdo pain
HSM
carditis
wheezing
neuro deficits
What are the symptoms of serum sickness-like reactions?
fever
pruritis
urticarial rash
arthralgia
without treatment duration of serum sickness?
1-2 weeks
Labs for serum-sickness or sickness-like
ESR
CBC - high or low WBC
C3, C4 - low
BUN, Cr
ANA, RF
Hepatic enzymes
Hep b screen
Heterophile antibody
IMmune complex assay
Urinalysis
ECG
Stool heme test
Treatment of serum sickness or sickness-like reaction
antihistamines
NSAIDs
corticosteroids - severe arthritis despite nsaids (prednisone 1-2mg/kg/day)
Indications for hospitalization of HSP
uncontrolled pain
significant GI bleeding
surgical abdomen
AKI
What medication should be use for HSP induced hypertension?
Calcium-channel blockers
What medication can be used to reduce proteinuria in HSP?
ACE-inhibitors
When are steroids indicated in HSP treatment?
severe GI symptoms
When does serum sickness usually present?
7-14 days after exposure to foreign serum protein
What are the usual symptoms of serum sickness?
fever
malaise
rash
arthralgias/arthritis
lymphadenopathy
angioedema
nephritis
Will C3, C4, CH50 be high or low in serum sickness?
LOW
How is serum sickness treated?
antihistamines (pruritis, angioedema), NSAIDs (arthralgia, arthritis), corticosteroids (severe arthritis despite NSAIDs)
Medications that can cause serum sickness
Penicillins
Trimethoprim sulfate
Minocycline
Meropenem
Bupropion
Carbamazepine
Phenytoin
Sulfonamides
Barbiturates
Criteria for atypical/incomplete kawasaki
Fever for at least five days + 2 of clinical features OR
Fever 7+ days without other explanation
+ CRP > 30 and/or ESR > 40 +
3 of
- Anemia
- PLT > 450
- Albumin < 30
- Elevated ALT
- WBC >15
- Sterile pyuria
What are the characteristics of Polyarteritis nodosa?
focal, pan-mural, necrotizing inflammation of small and medium-sized muscular arteries
What infections is polyarteritis nodosa associated with?
Strep
hepatitis b/c
What are the effects of polyarteritis nodosa on the following systems?
Renal
GI
CNS
Resp
Cardiac
Renal - proteinuria, abnormal urinary sediment, hypertension
GI - abdo pain secondary to gut vasculitis
CNS - seizures, hemiparesis
Resp - diffuse infiltrates, pulmonary hemorrhage, hemthorax
Cardiac - pericarditis, cardiomegaly, myocardial infarction, ECG changes
What is the management of polyarteritis nodosa?
corticosteroids
(prednisone 2mg/kg/day)
What emergent conditions can be the result of polyarteritis nodosa?
renal insufficiency
hypertension
CHF, MI, Dysrhythmia
GI vasculitis - bowel infarction, perforation, cholecystitis
Seizures, cranial nerve palsies
- creates aneurysms that can burst and cause hemorrhagic shock in any organ also
